WO2017210434A1 - Système de cordages tendineux rapportés - Google Patents

Système de cordages tendineux rapportés Download PDF

Info

Publication number
WO2017210434A1
WO2017210434A1 PCT/US2017/035463 US2017035463W WO2017210434A1 WO 2017210434 A1 WO2017210434 A1 WO 2017210434A1 US 2017035463 W US2017035463 W US 2017035463W WO 2017210434 A1 WO2017210434 A1 WO 2017210434A1
Authority
WO
WIPO (PCT)
Prior art keywords
chord
needle
distal conduit
proximal
conduit
Prior art date
Application number
PCT/US2017/035463
Other languages
English (en)
Inventor
Ryan Medema
Daniel Tomko
Jeffery Poehlmann
Michael Hunt
Kellen Moulton
Original Assignee
On-X Life Technologies, Inc.
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by On-X Life Technologies, Inc. filed Critical On-X Life Technologies, Inc.
Priority to US16/305,945 priority Critical patent/US11103350B2/en
Publication of WO2017210434A1 publication Critical patent/WO2017210434A1/fr
Priority to US17/411,174 priority patent/US20220039952A1/en

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2/00—Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
    • A61F2/02—Prostheses implantable into the body
    • A61F2/24—Heart valves ; Vascular valves, e.g. venous valves; Heart implants, e.g. passive devices for improving the function of the native valve or the heart muscle; Transmyocardial revascularisation [TMR] devices; Valves implantable in the body
    • A61F2/2442—Annuloplasty rings or inserts for correcting the valve shape; Implants for improving the function of a native heart valve
    • A61F2/2454—Means for preventing inversion of the valve leaflets, e.g. chordae tendineae prostheses
    • A61F2/2457—Chordae tendineae prostheses
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/00234—Surgical instruments, devices or methods, e.g. tourniquets for minimally invasive surgery
    • A61B2017/00238—Type of minimally invasive operation
    • A61B2017/00243—Type of minimally invasive operation cardiac
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0406—Pledgets
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0409—Instruments for applying suture anchors
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0417—T-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0419—H-fasteners
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/04—Surgical instruments, devices or methods, e.g. tourniquets for suturing wounds; Holders or packages for needles or suture materials
    • A61B17/0401—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors
    • A61B2017/0464—Suture anchors, buttons or pledgets, i.e. means for attaching sutures to bone, cartilage or soft tissue; Instruments for applying or removing suture anchors for soft tissue
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2210/00—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2210/0014—Particular material properties of prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof using shape memory or superelastic materials, e.g. nitinol
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F2220/00—Fixations or connections for prostheses classified in groups A61F2/00 - A61F2/26 or A61F2/82 or A61F9/00 or A61F11/00 or subgroups thereof
    • A61F2220/0025—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0075—Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements sutured, ligatured or stitched, retained or tied with a rope, string, thread, wire or cable

Definitions

  • Embodiments of the invention are in the field of cardiology-related medical devices. Background
  • Mitral valve prolapse is a significant cause of cardiovascular morbidity and mortality. As a result, surgical intervention is often required. As one of the surgical options currently available, mitral valve repair is well established and is applicable in patients with mitral valve prolapse due to degenerative mitral valve disease.
  • the techniques of mitral valve repair include inserting a cloth-covered ring around the valve to bring the leaflets into contact with each other (annuloplasty), removal of redundant/loose segments of the leaflets
  • chordae chordae
  • Figure 1 includes an embodiment with a needle and two pledgets.
  • Figures 2, 3, 4, 5, 6, 7 depict an embodiment of a method of deploying a chordae tendineae system.
  • Figure 8 includes an embodiment with multiple needles and pledgets.
  • Figure 9 includes an embodiment with multiple needles and pledgets.
  • Figure 10 includes an embodiment with multiple needles and pledgets.
  • Figures 11 (A), 11 (B), 11 (C), and 11 (D) depict an embodiment of a method of deploying a chordae tendineae system.
  • Figure 12 includes the use of various instances of an embodiment.
  • the chords shown therein may be the same length in some embodiments but different lengths in other embodiments.
  • Figures 13 and 14 show different deployment orientations for an embodiment.
  • Figure 15 includes an embodiment of a pledget which includes a conduit or ferrule.
  • Figure 16 includes an embodiment of a needle.
  • Figure 17 includes an embodiment of a method of deploying a chordae tendineae system.
  • Figures 18(A)- 18(F) depict varying chordae structures in embodiments of the invention.
  • a suture length affixed to a needle has already been separated from the remaining pledgets.
  • Figures 18(G)- 1(H) depict the embodiment of Figure 18(E) during different stages of its deployment.
  • Figures 19(A)- 19(B) depict the embodiment of Figure 18(E) during different stages of its deployment.
  • a suture length affixed to a needle has already been separated from the remaining pledgets.
  • chordal replacement replacement of diseased mitral valve chordae with expanded polytetrafluoroethylene (ePTFE) sutures is an established technique with good long-term results.
  • ePTFE expanded polytetrafluoroethylene
  • Various techniques have been described to assist the surgeon to establish the correct replacement chordal length.
  • few effective products have been developed to assist surgeons with this challenging procedure.
  • surgical approaches have centered on individual surgeon-based techniques including the use of a small tourniquet or weaving the suture through the leaflet to the mitral annulus and thereafter readjusting the length while the ventricle is filled under pressure.
  • Other conventional techniques and products require the surgeon to take a large role in the surgery.
  • Embodiments address various problems found in conventional systems.
  • An embodiment is a rapid deployment system that requires significantly less of the surgeon and dramatically shortens the duration of the surgery.
  • An embodiment includes a prosthesis system that allows a surgeon to quickly implant a prefabricated artificial chordae tendineae prosthesis (e.g., to repair mitral valve regurgitation or prolapse).
  • the embodiment allows the surgeon to fully deploy the implant, completely or almost completely eliminating the need for the surgeon to tie complicated and time-consuming knot bundles, or crimp additional components to secure the prosthesis (as is the case with conventional crimping systems).
  • Embodiments allow the surgeon to pull a strand or strands of ePTFE suture and a series of pledgets through cardiac tissues to install the implant, completely eliminating the need for the surgeon to tie complicated and time-consuming knot bundles, or crimp additional
  • embodiments allow for minimally invasive (e.g., through a space between a patient's ribs) and trans-catheter deployment of the prosthesis, ultimately enabling quicker procedures and better patient outcomes.
  • Embodiments of the invention addressed herein include various apparatuses, systems, and surgical techniques.
  • Figure 1 includes an embodiment.
  • the overall concept of an embodiment of the prosthesis is a length of suture (e.g., monofilament or braided), coupled with a needle (e.g., metallic needle) and at least two pledgets— a "terminal" pledget and one (or more)
  • a needle e.g., metallic needle
  • the distance between the deployable and terminal pledgets is a pre-determined and fixed length, and generally becomes or corresponds with the effective length of the artificial chord. This is a pre-configured construct, delivered to the surgeon sterile and ready to use. No additional supplies or materials are necessary.
  • Figures 18(A)- 18(F) depict varying chordae structures in embodiments of the invention. For each of these figures a length of suture or chord that terminates with a needle is not shown. For example, the figures are analogous to the portion of Figure 1 extending from the terminal pledget to the deployable pledget but do not include the portion of Figure 1 extending from the deployable pledget to the needle.
  • Figures 18(G)- 18(H) depict the embodiment of Figure 18(E) during different stages of its deployment.
  • Figure 18(A) includes mechanical knots or melted ePTFE sutures 101, 105, PTFE strips 102, 103, and ePTFE suture 104.
  • Figure 18(B) includes components similar to Figure 18(A) but further adds PTFE felt pledgets 106, 107 in place of the PTFE strips of Figure 18(A).
  • Figure 18(F) is similar to Figure 18(B) but includes pledgets shaped differently from those of Figure 18(B).
  • Figure 18(C) is similar to Figure 18(A) but foregoes PTFE strips or pledgets and instead relies on knots 101, 105 being enlarged and configured to compress(e.g., when passing through tissue or a catheter) but then expand to offer secure purchase to leaflet or papillary tissue.
  • Figure 18(D) includes components similar to Figure 18(A) but further adds thickened ePTFE suture portions 108, 109 in place of the PTFE strips of Figure 18(A).
  • Figure 18(E) includes components similar to Figure 18(A) but further adds slotted ePTFE tubes 110, 111 in place of the PTFE strips of Figure 18(A).
  • the slotted tube embodiment of Figure 18(E) offers a small cross sectional diameter (when collapsed, such as Figure 18(G)) while still offering a broad and reliable anchoring feature (once deployed via 90 degree rotation, such as Figure 18(H)).
  • the slotted tube is sometimes referred to herein as a "fluke” or “ferrule” or some form of conduit (a pipe or tube or trough through which something (such as suture) passes).
  • a conduit need not be an overly extended cylinder having that is completely straight or has any particular length.
  • the conduit may include a mere trough that acts to restrain the suture therein.
  • Embodiments of Figures 18(A)- 18(F) feature a premeasured length of ePTFE 104 and a method of capping both ends of the construct with PTFE and/or ePTFE components (which may be rigid in some embodiments). ePTFE and PTFE have excellent
  • Each of these assemblies comprises artificial mitral chordae tendineae prosthesis.
  • Materials for pledgets may include, for example, ePTFE/PTFE tubing, ePTFE/PTFE felt, Silicone, Polypropylene, Shape Memory Polymers, Shape Memory Foam, Nitinol, PCU or PET.
  • Pledgets may be permanent, or may feature biodegradable elements to facilitate their deployment and incorporation into native tissues.
  • a single piece of suture may pass through the pledget while in other embodiments two or more sutures are coupled by the pledget.
  • Multiple sutures may couple together via a knot or may be fused together (e.g., via melted or heated ePTFE).
  • the first and second suture lengths may include separate ePTFE strands joined together via heat (e.g., laser), weld, chemical reaction, and the like.
  • Embodiments of pledgets may include a variation on the slotted tube of Figure 18(G).
  • a central slot is located in the fluke such that a knot may nest within the slot to create a streamlined profile.
  • this allows two or more sutures to be knotted together with the knot not constituting a barrier to passage through tissue.
  • the knot may be made in a single piece of suture but used to hold the fluke pledget in place.
  • a knot bundle is originally placed in line with tube (for easy tissue penetration). When a suture is cut the suture slides and the knot bundle rests perpendicular at the center of the tube.
  • pledgets are similar in form and function to a molly bolt, having a slim profile that deforms resulting in a wider cross section.
  • FIG. 1 Another embodiment of a pledget is similar to an umbrella, including struts with fabric that are retracted when passing through tissue and then deploy to create a wide cross section.
  • a pledget includes a coil of wire (e.g., shape memory alloy) or polymer (shape memory polymer) that straightens out during deployment but then, based on heat or some other activity, resumes its programmed shape (e.g., coil) that resists passage through tissue.
  • a coil of wire e.g., shape memory alloy
  • polymer shape memory polymer
  • Figures 18(A)- 18(H) show not only many embodiments for deployable pledgets, such as pledgets 102, 106, 108, 110, those figures also show many embodiments for terminal pledgets, such as pledgets 103, 107, 109, 111.
  • the terminal pledget distributes the chordal force onto a larger area in order to protect the native tissues from damage.
  • Some embodiments are single chordal member designs while others use purposeful routing of the suture to form a continuous construct offering multiple chordal members.
  • An embodiment of a terminal pledget includes a relatively larger flexible "button" (made of, for example, silicone) over molded or cast onto the suture tail, to distribute load and eliminate stress concentrations.
  • An embodiment for terminal pledgets includes a method for joining multiple strands into a single pledget. Multiple strands may be used for many embodiments.
  • An embodiment for a terminal pledget includes a saucer shape over molded/cast onto suture tails. Doing so distributes load while allowing the tip of the saucer to be flexible.
  • Materials for terminal pledgets include, for example, ePTFE/PTFE tubing, ePTFE/PTFE felt, Silicone, Polypropylene, Shape Memory Polymers, Shape Memory Foam, Nitinol, PCU, PET, PLA, PGA, PLGA.
  • Pledgets may be permanent, or may feature biodegradable elements to facilitate their incorporation into native tissues.
  • Figure 8 includes an embodiment that features multiple (two or more) "Deployable Pledgets” configured to a single “Terminal Pledget", which results in multiple chordal members.
  • Embodiments may be achieved with separate independent suture strands, or the purposeful routing of a single strand to fabricate multiple chordal members.
  • an alternative embodiment may include loops such that a single suture may start at the terminal pledget, then pass through a first deployable pledget and back through the first deployable pledget back to the terminal pledget (thereby forming a loop). The process may then be repeated with the same suture to attach additional loops to one or more additional pledgets.
  • Figure 9 includes an embodiment that features one "deployable pledget” coupled to another deployable pledget.
  • Figure 10 includes an embodiment that features one "deployable pledget” coupled to multiple deployable pledgets.
  • Needles e.g., metallic needles
  • the single and multiple chord member embodiments of Figures 9-10 both provide that when an embodiment is installed between a leaflet and papillary muscle each pledget passes through only one tissue (rather than previous embodiments where some pledgets must pass through both tissues).
  • element 306 of Figure 9 deploys through a leaflet and element 304 deploys through papillary muscle.
  • An embodiment eliminates the need for surgeon-tied knots and crimping to execute artificial mitral chordae tendineae. Also, such an embodiment requires no delivery device and limited external supplies to implement. Simply put, in an embodiment the clinician penetrates native cardiac tissues and then pulls the device through the tissue until termination, finally trimming off the unused portion. Previously, the surgeon had many steps and required a great deal of skill and operating room time to fabricate and implant artificial chordae tendinae devices, complete with many manual knots.
  • An embodiment includes a sealed kit (e.g., package) including a first suture portion coupled between first and second pledgets and a second suture portion coupled between the second pledget and a needle, (e.g., Figures 9 or 10)
  • first and second suture portions are monolithic with each other but not so in other embodiments.
  • one of the first and second pledgets is configured to pass through tissue with limited resistance and the other of the first and second pledgets is configured to resist passage through tissue with limited resistance.
  • one of the first and second pledgets comprises a fluke that in a first configuration has a long axis generally collinear with a long axis of one of the first and second suture portions and in a second configuration has a long axis generally orthogonal or at least non-collinear with a long axis of one of the first and second suture portions.
  • An embodiment includes a kit that includes multiple chords in a variety of predetermined lengths, which will allow the surgeon to accurately achieve the correct geometry for that particular patient. This feature eliminates or reduces the variability that comes from a hand-tied prosthesis, and ultimately offers a more consistent product.
  • the surgeon may elect to place several prostheses about a single leaflet or multiple leaflets. In such a case the surgeon may simply repeat the process in, for example, Figure 1 to implant more than one chord.
  • the papillary muscle and leaflet are such that they can handle several "pokes" or penetrations by delivery needles to implant chordae, considering the relatively small diameter of the delivery needles.
  • the surgeon has an "in-and-out technique” that capitalizes on simplicity and quickness and the ability to deploy 1 or more chordae.
  • three different "shots” or penetrations with delivery needles (to deploy 3 chordae) would be tolerable by papillary muscle and a leaflet.
  • the prosthesis that is implanted is comprised entirely of ePTFE and/or PTFE, which allows for excellent biocompatibility and tissue ingrowth into the construct.
  • ePTFE and/or PTFE which allows for excellent biocompatibility and tissue ingrowth into the construct.
  • other embodiments use other materials for the chord (e.g., nylon) and the fluke of the prosthesis may be fabricated from a polymer or metal (e.g., Nitinol) that allows the fluke to collapse about the chord.
  • a polymer or metal e.g., Nitinol
  • different versions of those same embodiments may include PTFE or other similar materials.
  • embodiments may provide materials with doping.
  • the ePTFE and/or PTFE materials described immediately above may be doped with any radiopaque material such as bismuth, barium, tungsten, gold, platinum, etc.
  • the doping agent makes the implant ends radiopaque such that the surgeon can monitor the position of the implant during or after surgery.
  • the orientation of the papillary muscle depends on the individual. Sometimes the muscle is in the base of the heart wall and rises up vertically like a water tower, on others it is on the side of the ventricle and juts out more horizontally. The surgeon may grab the tip of the muscle with forceps and manipulate the muscle to get the preferred orientation for surgery.
  • the system is a single use disposable attachment device containing a single prosthesis preloaded into the device.
  • the system is delivered to the surgeon sterile.
  • An embodiment translates to a minimally invasive procedure (e.g., trans-catheter approach or through an intercostal space via transthoracic entry). Since conventional systems require additional instrumentation or surgeon intervention to secure the prosthesis, the conventional systems may have difficulty translating to minimally invasive or trans-catheter deployment. Conventional systems require an open approach and several instruments and components. In contrast, with an embodiment the surgeon inserts one or more sutures lengths into the patient's tissue to deploy the prosthesis and the surgery is complete.
  • Embodiments may include no knot but instead couple the chords to each other with a weld, or the chords may be monolithic with each other where the coupling is just a location where the cords couple to each other.
  • the chords may be cut or otherwise formed from a single piece of ePTFE.
  • Various embodiments have been described in conjunction with mitral valve repair but other uses are possible such as tricuspid valve repair or even suturing in locations apart from the heart.
  • orthopedic applications such as suturing connective tissue to bone or two soft tissues together in a rapid manner (e.g., coupling tendon to muscle).
  • a surgeon may anchor a loose ligament or tendon using an embodiment of the system.
  • One end of the system is secured to the free end of the ligament, while the other is anchored in the bone.
  • the system may constitute a general anchoring or connective prosthesis.
  • a pledget is to be interpreted as a buttress or shield to prevent, for example, a suture/coupling member from cutting tissue over time due to repetitive movement or tension of the suture/coupling member.
  • materials are not restricted to ePTFE and/or PTFE and may include, for example (for the chords and/or flukes) silk, nylon, biodegradable materials (e.g., for suturing that is temporary in nature such as is the case with some orthopedic procedures) such as polyglycolic Acid (PGA), polylactic acid (PLA), poly(lactic-co-glycolic acid) (PLGA), polydioxanone (PDS), poly(orthoester) (POE), polycaprolactone (PCL), polymethylmethacrylate (PMMA), copolymer blends of the above, and the like.
  • Other embodiments may include biological tissue for chord lengths.
  • the system need not be limited to just one material.
  • the chords may be PTFE and the flukes may be ePTFE.
  • a fluke includes objects like conduits or ferrules that pass the chord there through but then anchor the chord by preventing an end of the chord from passing through the fluke.
  • a fluke is similar to a "treasury tag” or India tag used to fasten sheets of paper together or to a folder.
  • Such a tag includes lace/chord with a tag (e.g., metal or ePTFE) at each end (where the ends are sharpened in some embodiments).
  • the tags may be threaded through apertures in documents, tissue, and the like.
  • the tag may be orthogonal to the lace upon deployment but in line with the lace while traversing an aperture.
  • the tag may have a slot or aperture on one half of the cylinder that comprises the tag such that the lace may move from in-line with the tag to orthogonal to the tag (see Figure 18(E)).
  • the lace/chord may or may not be resilient.
  • Embodiments described herein reduce variability over current methods.
  • a current method of hand tying artificial chordae prosthetics out of ePTFE suture requires skill on the part of the surgeon.
  • Each knot is comprised of between eight to ten throws in ePTFE suture. The knots could be tied incorrectly or the surgeon could miscount the requisite number of throws resulting in an inferior knot.
  • an embodiment eliminates the variability that can be observed in the current method of hand tying artificial chordae prosthetics.
  • An embodiment reduces operating room (OR) time compared to current methods. Since the prosthetic is not fabricated during surgery, the duration that the patient is in surgery is reduced.
  • a staple or cinch may be coupled to the chord ends.
  • a cinch/staple/crimped polymeric or metal sleeve may be attached to the distal chord ends.
  • a needle such as needle 201 of Figure 1
  • the needle may couple to a fluid source, which may deploy a chord (e.g., the cord of Figure 1) from the needle based on fluid pressure (e.g., from a plunger).
  • a chord e.g., the cord of Figure 1
  • fluid pressure e.g., from a plunger
  • other embodiments are not so limited and may include inserting the needle through a space between the patient's ribs.
  • the system 200 of Figure 1 may be delivered transcatheter or via minimally invasive instrumentation through a right mini thoracotomy.
  • the entirety of the prosthesis 200 is housed within the catheter (or MIS instrument), delivered to the left atrium superior to the mitral leaflet, and then deployed through the leaflet tissue and papillary muscle.
  • a stiff rod-like member (which is still flexible enough to be delivered via catheter) may accompany needle 201 through the catheter (or MIS instrument) and drive the needle and deployable pledget through the leaflet and then through papillary muscle.
  • Figure 12 shows a portion of the ferrule between two knots or obstructions to hold the ferrule in place. Also, the portion of the suture including the needle is not always shown in figures presented herein.
  • the needle may have an outer diameter equal to, greater than, or less than the maximum outer diameter of the ferrule (also known as a conduit or T-Bar).
  • Figure 1 includes an artificial chordae tendineae system 200 comprising: a first needle 201; a flexible first chord 202 coupled to a proximal end portion 203 of the first needle; a first proximal conduit 204 coupled to a proximal end portion 205 of the first chord; a first distal conduit 206 coupled to the first chord between the first proximal conduit and the first needle.
  • the first chord includes a long axis (see axis 288 of Figure 18(H)) when the first chord is fully extended into a linear orientation.
  • the first proximal conduit includes a long axis, and the first distal conduit includes a long axis (see axis 284 of Figure 18(H)).
  • the long axes of the first proximal and distal conduits are substantially parallel to the long axis of the first chord in a first system orientation (see Figure 18(G) and element 206 of Figure 1 (A)); wherein the first proximal and distal conduits are each configured to rotate (see action 286 of Figure 18(H) and 204, 206 of Figure 19(B)) when permanently deployed into a patient in a second system orientation such that the long axes of the first proximal and distal conduits are not parallel (see, e.g., the relationship between axes 284, 288 of Figure 18(H)) to the long axis of the first chord.
  • An embodiment may include a kit having two or more of system 200 of Figure 1.
  • Each system may include a suture having a length between elements 203, 205 that are the same or that are unequal to each other.
  • Figure 12 includes a first proximal obstruction 812 between the first proximal conduit (or pledget 804 as shown in Figure 12) and a proximal end 812 of the first chord 802; and a first distal obstruction 813 between the first distal conduit 806 and the first needle (no longer shown in Figure 12 after having been severed); a second distal obstruction 818 between the first proximal and distal conduits.
  • Each of the first proximal obstruction 812, the first distal obstruction 813, and the second distal obstruction 818 includes an outer diameter greater than an outer diameter of the first chord 802. The obstructions may simply be knots of suture 802.
  • the first chord 202 is monolithic and passes through the first distal conduit 206.
  • chord 802 constitutes a single suture length that extends from end 812 to end 812' .
  • the first chord is monolithic and passes through the first proximal 804 and distal 806 conduits.
  • the chord may not completely pass through a portion, such as a proximal pledget.
  • the suture may be non-monolithic and coupled together from numerous separate suture lengths.
  • portions of the distal conduit 806 are substantially statically coupled to the first chord 802 so the portions of the first distal conduit 806 do not slide along the first chord by more than 1 mm. This may be due to, for example, obstructions 818, 813.
  • the first distal conduit (e.g., element 206 of Figure 1) is deformable.
  • the conduit may include a polyurethane shape memory polymer that expands when warmed by bodily fluids.
  • the first chord 202 includes a first chord material
  • the first proximal conduit 204 includes a first proximal conduit material
  • the first distal conduit 206 includes a first distal conduit material that is the same as the first chord material and the first proximal conduit material (PTFE or ePTFE).
  • Figure 10 illustrates proximal conduit 304, first distal conduit 306, suture length 302, first needle 301, second needle 30 ; a flexible second chord 302'coupled to a proximal end portion of the second needle, the first proximal conduit 304 being coupled to a proximal end portion of the second chord 302'; a second distal conduit 306' coupled to the second chord between the first proximal conduit and the second needle.
  • Figure 10 includes a third needle 301"; a flexible third chord 302" coupled to an end portion of the third needle and to the first proximal conduit 304; wherein the third chord is between the first proximal conduit and the third needle.
  • Figure 9 includes proximal conduit 404, first distal conduit 406, suture length 402, first needle 401, second needle 401 '; a flexible second chord 402' (which may or may not be monolithic with chord/suture 402) coupled to an end portion of the second needle and to the first proximal conduit 404; wherein the second chord is between the first proximal conduit and the second needle.
  • Figure 15 includes first distal conduit 506, which includes first face 521 and second face 522; one of the first and second faces includes a first aperture 523; a sidewall 524 of the first conduit, located between the first and second faces, includes a sidewall aperture 525 that does not directly connect to the first aperture.
  • the sidewall aperture 525 is configured to include a portion of the first chord when the system is in the second system orientation (e.g., Figure 18 (H)) but not when the system is in the first system orientation (e.g., Figure 18(G)).
  • First distal conduit 506 has a beveled edge 526 to facilitate traversal of the first distal conduit through tissue.
  • the first distal conduit 506 includes first end region 52 and second end region 522' and one of the first and second end regions includes a first aperture 523 through which suture passes.
  • it is end portion 52 that includes aperture 523.
  • the end region (region 522' in this case) opposite the end region with aperture 523 (region 521 ' in this case) does not directly contact a portion of the first chord when the system is in the second system orientation (e.g., Figure 18 (H)— the position taken during permanent implantation) but does directly contact a portion of the first chord when the system is in the first system orientation (e.g., Figure 18(G)— the position taken during tissue traversal).
  • Embodiments may include conduits which include a knot or coupling between two pieces of suture.
  • Other embodiments may include terminal ends of two suture lengths whereby each length includes a knot included within the conduit.
  • Other embodiments may include conduits that couple two suture lengths together. In such a case the suture lengths may or may not directly contact each other.
  • Other embodiments may include a conduit that includes a knot in a monolithic suture length that traverses the conduit.
  • Other embodiments may include a conduit immediately adjacent a knot in a monolithic suture length that traverses the conduit.
  • Figure 16 includes a first needle 601 that has a first maximum outer diameter 630; the first distal conduit has a second maximum outer diameter (see diameter 531 of Figure 15); and the first chord has third maximum outer diameter 632 that is less than (a) the first maximum outer diameter, and (b) the second maximum outer diameter.
  • Figure 17 includes a method 1700.
  • Block 1701 includes providing a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal conduit coupled to a proximal end portion of the first chord; a first distal conduit coupled to the first chord between the first proximal conduit and the first needle.
  • Block 1702 includes traversing a mitral leaflet with the first needle and the first chord ( Figure 3).
  • Block 1703 includes traversing the mitral leaflet with the first distal conduit while a long axis of the first distal conduit is substantially parallel to a long axis of a portion of the first chord immediately adjacent the first distal conduit ( Figure 5).
  • Block 1704 includes traversing papillary muscle with the first needle and the first chord ( Figure 2).
  • Block 1705 includes traversing the papillary muscle with the first distal conduit while the long axis of the first distal conduit is substantially parallel to the long axis of a portion of the first chord immediately adjacent the first distal conduit ( Figure 4).
  • Block 1706 includes in response to traversing the mitral leaflet and the papillary muscle with the first needle, simultaneously traversing the mitral leaflet and the papillary muscle with the first chord ( Figure 6).
  • Block 1707 includes rotating the first distal conduit so the long axis of the first distal conduit is not substantially parallel to the long axis of the portion of the first chord immediately adjacent the first distal conduit ( Figure 7).
  • Block 1708 includes rotating the first proximal conduit so a long axis of the first proximal conduit is not substantially parallel to the long axis of a portion of the first chord immediately adjacent the first proximal conduit.
  • Block 1709 includes in response to rotating the first distal conduit, positioning the distal conduit against a first side of one of the papillary muscle and the mitral leaflet ( Figure 7).
  • Block 1710 includes in response to rotating the first proximal conduit, positioning the proximal conduit against a first side of another of the papillary muscle and the mitral leaflet ( Figure 7).
  • Figures 2, 3, 4, 5, 6, 7 illustrate initial penetration of the papillary muscle and then the leaflet but other embodiments reverse the process.
  • These figures also show versions of pledgets that could be PTFE discs, conduits (e.g., Figure 15), and the like.
  • the block pledgets of Figure 2 are somewhat generic and can include, for example, the embodiments of Figures 18(A)-18(E).
  • Figures 11(A), 11(B), 11(C), 11(D) show a method of deployment with a PTFE proximal disc 704 and distal conduit 706 being deployed to papillary muscle and then a leaflet but other embodiments occur in reverse order (i.e., through the mitral valve and then papillary muscle or other tissue the physician desires to anchor the cord to).
  • Example 1 includes an artificial chordae tendineae system comprising: a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal conduit coupled to a proximal end portion of the first chord; a first distal conduit coupled to the first chord between the first proximal conduit and the first needle;
  • first chord includes a long axis when the first chord is fully extended into a linear orientation
  • first proximal conduit includes a long axis
  • first distal conduit includes a long axis
  • the long axes of the first proximal and distal conduits are substantially parallel to the long axis of the first chord in a first system orientation
  • the first proximal and distal conduits are each configured to rotate when permanently deployed into a patient in a second system orientation such that the long axes of the first proximal and distal conduits are not parallel to the long axis of the first chord.
  • some embodiments include at least two pledgets.
  • Those pledgets may include conduits such as element 506 of Figure 15.
  • Two conduit pledgets may be advantageous when, for example, both pledgets will be advanced through tissue.
  • element 406 may be advanced through a leaflet and element 404 may be advanced through papillary tissue.
  • Figure 9 shows a needle for each of the conduits some embodiments are not so limited and may only include a single needle. In such a case (e.g., Figure 1 where elements 206 and 204 are both conduits) only one of the conduits may be advanced through tissue (e.g., leaflet and papillary muscle) while the other conduit merely is placed against tissue without advancing through it.
  • Conduits such as those of Figure 15, Figure 18(E), and Figure 12 have advantages when it comes to advancing through tissue.
  • the axis of the conduit and chord may be advanced through tissue when oriented in a low resistance profile, such as Figure 18(G) or Figure 1 (A).
  • the conduit may then rotate into a high resistance profile when permanently implanted and placed adjacent tissue, such as Figure 18(H) or Figure 19(B).
  • Example 2 includes the system of example 1 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal conduit coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the second proximal conduit and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, the second proximal conduit includes a long axis, and the second distal conduit includes a long axis; wherein the long axes of the second proximal and distal conduits are substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second proximal and distal conduits are each configured to rotate when permanently deployed into a patient in an additional second system orientation such that the long axes of the second proximal and distal conduits are not parallel to the long axis of the second chord; wherein the first chord has a first length between
  • a kit may include multiple structures such as system 200 of Figure 1.
  • the structures may each have the same chord length.
  • Example 3 includes the system of example 1 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal conduit coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the second proximal conduit and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, the second proximal conduit includes a long axis, and the second distal conduit includes a long axis; wherein the long axes of the second proximal and distal conduits are substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second proximal and distal conduits are each configured to rotate when permanently deployed into a patient in an additional second system orientation such that the long axes of the second proximal and distal conduits are not parallel to the long axis of the second chord; wherein the first chord has a first length between
  • a kit may include multiple structures such as system 200 of Figure 1.
  • the structures may each have a different chord length.
  • Example 4 includes the system of example 1, comprising: a first proximal obstruction between the first proximal conduit and a proximal end of the first chord; and a first distal obstruction between the first distal conduit and the first needle; a second distal obstruction between the first proximal and distal conduits; wherein each of the first proximal obstruction, the first distal obstruction, and the second distal obstruction includes an outer diameter greater than an outer diameter of the first chord.
  • Figure 12 shows how knots 818, 813 can keep conduit 806 from sliding along chord 802.
  • Such "bracketing" knots can be used for proximal conduits (e.g., conduit 404 of Figure 9) as well.
  • Example 5 includes the system of example 1, wherein the first chord is monolithic and passes through the first distal conduit.
  • Example 6 includes the system of example 1, wherein the first chord is monolithic and passes through the first proximal and distal conduits.
  • chord 202 may be monolithic and constitute a single piece of suture (all formed from one source without joining several pieces together with knots, welds, our couplers) that extends from needle 201 to pledget 204.
  • Example 7 includes the system of example 1, wherein portions of the first proximal and distal conduits are substantially statically coupled to the first chord so the portions of the first proximal and distal conduits do not slide along the first chord by more than 1 mm.
  • Figure 12 shows how knots 818, 813 can keep conduit 806 from sliding along chord 802.
  • Such "bracketing" knots can be used for proximal conduits (e.g., conduit 404 of Figure 9) as well.
  • Example 8 includes the system of example 1, wherein the first distal conduit is deformable.
  • distal conduit is likely to be the pledget that advances through tissue.
  • distal pledget 906 is advanced through tissue twice whereas proximal pledget 904 is not advanced through tissue.
  • pledget 906 may be made deformable (e.g., Nitinol) whereas pledget 904 is not necessarily made deformable.
  • Example 9 includes the system of example 1, wherein the first chord includes a first chord material, the first proximal conduit includes a first proximal conduit material, and the first distal conduit includes a first distal conduit material that is the same as the first chord material and the first proximal conduit material.
  • Example 10 includes the system of example 9, wherein the first distal conduit material includes at least one of polytetrafluoroethylene and expanded
  • Example 11 includes the system of example 1 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle, the first proximal conduit being coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the first proximal conduit and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, and the second distal conduit includes a long axis; wherein the long axis of the second distal conduit is substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second distal conduit is configured to rotate when permanently deployed into the patient in an additional second system orientation such that the long axis of the second distal conduit is not parallel to the long axis of the second chord.
  • proximal pledget 304 may be advanced through papillary tissue while the other "arms" are each advanced through leaflet tissue, all using minimal profiles for advancing through tissue (e.g., Figure 18(G)) and obstructing profiles for permanent implantation (e.g., Figure 18(H)).
  • distal pledgets 1006, 1006' may be advanced through papillary and leaflet tissue while proximal pledget 1004 is located adjacent papillary tissue.
  • the distal pledgets may include minimal profiles for advancing through tissue (e.g., Figure 18(G)) and obstructing profiles for permanent implantation (e.g., Figure 18(H)).
  • pledgets 1006, 1006' are not limited to conduit embodiments and pledgets may use other embodiments (e.g., Figure 18(A)) described or relied upon herein.
  • Example 12 includes the system of example 11 comprising: a third needle; a flexible third chord coupled to an end portion of the third needle and to the first proximal conduit; wherein the third chord is between the first proximal conduit and the third needle.
  • the needle 301" of Figure 10 helps advance pledget 304 through papillary tissue.
  • Example 13 includes the system of example 1 comprising: a second needle; a flexible second chord coupled to an end portion of the second needle and to the first proximal conduit; wherein the second chord is between the first proximal conduit and the second needle.
  • the needle 40 of Figure 9 helps advance pledget 404 through papillary tissue.
  • Example 14 includes the system of example 1, wherein: the first distal conduit includes first and second faces; one of the first and second faces includes a first aperture; a sidewall of the first conduit, located between the first and second faces, includes a sidewall aperture that does not directly connect to the first aperture; the sidewall aperture is configured to include a portion of the first chord when the system is in the second system orientation but not when the system is in the first system orientation.
  • Example 15 includes the system of example 1, wherein the first distal conduit has a beveled edge to facilitate traversal of the first distal conduit through tissue. [0105] For example, see Figure 15.
  • Example 16 includes the system of example 1, wherein: the first needle has a first maximum outer diameter; the first distal conduit has a second maximum outer diameter; and the first chord has third maximum outer diameter that is less than (a) the first maximum outer diameter, and (b) the second maximum outer diameter.
  • Example 17 includes a method comprising providing a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal conduit coupled to a proximal end portion of the first chord; a first distal conduit coupled to the first chord between the first proximal conduit and the first needle; traversing a mitral leaflet with the first needle and the first chord; traversing the mitral leaflet with the first distal conduit while a long axis of the first distal conduit is substantially parallel to a long axis of a portion of the first chord immediately adjacent the first distal conduit; traversing papillary muscle with the first needle and the first chord; traversing the papillary muscle with the first distal conduit while the long axis of the first distal conduit is substantially parallel to the long axis of a portion of the first chord immediately adjacent the first distal conduit; in response to traversing the mitral leaflet and the papillary muscle with the first needle, simultaneously traversing the mitral leaflet and the papillary muscle with the first needle
  • Figures 2-6 illustrate advancing a single pledget through tissue twice.
  • the pledget may be ePTFE, felt, conduits (e.g., Figure 15), and the like.
  • the traversal may begin with papillary muscle and end with the leaflet. However, the process may be reversed and begin with leaflet tissue and end with papillary muscle.
  • Figures 11(A)-11(D) show a process similar to Figures 2-6 but explicitly include two types of pledgets: a deploy able or lead pledget 706 (which may be a low profile conduit such as Figure 15) and a terminal or obstructing profile pledget 704 (which is not a conduit like the embodiment of Figure 15) that is not necessarily meant to be advanced through tissue.
  • Figures 13 and 14 illustrate how a deployable pledget (e.g., Figure 15) may be permanently coupled to leaflet tissue (e.g., Figure 13) or papillary tissue (e.g., Figure 14).
  • Example 18 includes the method comprising traversing the mitral leaflet with the first needle and the first chord after traversing the papillary muscle with the first needle and the first chord.
  • Example 19 includes an artificial chordae tendineae system comprising: a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal pledget coupled to a proximal end portion of the first chord; a first distal conduit coupled to the first chord between the first proximal pledget and the first needle; wherein the first chord includes a long axis when the first chord is fully extended into a linear orientation, and the first distal conduit includes a long axis; wherein the long axis of the first distal conduit is substantially parallel to the long axis of the first chord in a first system orientation; wherein the distal conduit is configured to rotate when permanently deployed into a patient in a second system orientation such that the long axis of the distal conduit is not parallel to the long axis of the first chord.
  • Figures 11(A)- 11(D) and 12-14 illustrate embodiments with a proximal pledget (e.g., element 704 of Figure 11(A)) that does not necessarily include a conduit and a distal conduit (e.g., element 706 of Figure 11(A)).
  • a proximal pledget e.g., element 704 of Figure 11(A)
  • a distal conduit e.g., element 706 of Figure 11(A)
  • Example 20 includes the system of example 19 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal pledget coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the second proximal pledget and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, and the second distal conduit includes a long axis; wherein the long axis of the second distal conduit is substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second distal conduit is configured to rotate when permanently deployed into a patient in an additional second system orientation such that the long axis of the second distal conduit is not parallel to the long axis of the second chord; wherein the first chord has a first length between its first proximal pledget and first distal conduit and the second chord has a second length between its second proximal pledget and
  • Example 21 includes the system of example 19 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal pledget coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the second proximal pledget and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, and the second distal conduit includes a long axis; wherein the long axis of the second distal conduit is substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second distal conduit is configured to rotate when permanently deployed into a patient in an additional second system orientation such that the long axis of the second distal conduit is not parallel to the long axis of the second chord; wherein the first chord has a first length between its first proximal pledget and first distal conduit and the second chord has a second length between its second proximal pledget and
  • Example 22 includes the system of example 19, comprising: a first distal obstruction between the first distal conduit and the first needle; a second distal obstruction between the first proximal pledget and first distal conduit; wherein each of the first distal obstruction and the second distal obstruction includes an outer diameter greater than an outer diameter of the first chord.
  • Example 23 includes the system of example 19, wherein the first chord is monolithic and passes through the first distal conduit.
  • Example 24 includes the system of example 19, wherein the first chord is monolithic and passes through the first proximal pledget and the first distal conduit.
  • Example 25 includes the system of example 19, wherein a portion of the first distal conduit is substantially statically coupled to the first chord so the portion of the first distal conduit does not slide along the first chord by more than 1 mm.
  • Example 26 includes the system of example 19, wherein the first distal conduit is deformable.
  • Example 27 includes the system of example 19, wherein the first chord includes a first chord material, the first proximal pledget includes a first proximal pledget material, and the first distal conduit includes a first distal conduit material that is the same as the first chord material and the first proximal pledget material.
  • Example 28 includes the system of example 27, wherein the first distal conduit material includes at least one of polytetrafluoroethylene and expanded
  • Example 29 includes the system of example 19 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle, the first proximal pledget being coupled to a proximal end portion of the second chord; a second distal conduit coupled to the second chord between the first proximal pledget and the second needle; wherein the second chord includes a long axis when the second chord is fully extended into a linear orientation, and the second distal conduit includes a long axis; wherein the long axis of the second distal conduit is substantially parallel to the long axis of the second chord in an additional first system orientation; wherein the second distal conduit is configured to rotate when permanently deployed into the patient in an additional second system orientation such that the long axis of the second distal conduit is not parallel to the long axis of the second.
  • Example 30 includes the system of example 29 comprising: a third needle; a flexible third chord coupled to an end portion of the third needle and to the first proximal pledget; wherein the third chord is between the first proximal pledget and the third needle.
  • Example 31 includes the system of example 19 comprising: a second needle; a flexible second chord coupled to an end portion of the second needle and to the first proximal pledget; wherein the second chord is between the first proximal pledget and the second needle.
  • Example 32 includes the system of example 19, wherein: the first distal conduit includes first and second faces; one of the first and second faces includes a first aperture; a sidewall of the first conduit, located between the first and second faces, includes a sidewall aperture that does not directly connect to the first aperture; the sidewall aperture is configured to include a portion of the first chord when the system is in the second system orientation but not when the system is in the first system orientation.
  • Example 33 includes the system of example 19, wherein the first distal conduit has a beveled edge to facilitate traversal of the first distal conduit through tissue.
  • Example 34 includes the system of example 19, wherein: the first needle has a first maximum outer diameter; the first distal conduit has a second maximum outer diameter; and the first chord has third maximum outer diameter that is less than (a) the first maximum outer diameter, and (b) the second maximum outer diameter.
  • Example 35 includes an artificial chordae tendineae system comprising: a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal pledget coupled to a proximal end portion of the first chord; a first distal pledget coupled to the first chord between the first proximal pledget and the first needle.
  • Figures 18(B) or 18(F) (which no longer show a needle that was coupled to element 101) has two pledgets, neither of which are necessarily conduits.
  • Figure 2 includes two symbolic pledgets 204, 206, either or both of which may take on forms shown in any of Figures 18(A)-18(F) or elsewhere herein.
  • Example 36 includes the system of example 35 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal pledget coupled to a proximal end portion of the second chord; a second distal pledget coupled to the second chord between the second proximal pledget and the second needle; wherein first chord has a first length between its first proximal pledget and first distal pledget and the second chord has a second length between its second proximal pledget and second distal pledget substantially equal to the first length.
  • Example 37 includes the system of example 35 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle; a second proximal pledget coupled to a proximal end portion of the second chord; a second distal pledget coupled to the second chord between the second proximal pledget and the second needle; wherein first chord has a first length between its first proximal pledget and first distal pledget and the second chord has a second length between its second proximal pledget and second distal pledget that is unequal to the first length.
  • Example 38 includes the system of example 35, wherein the first chord is monolithic and passes through the first distal pledget.
  • Example 39 includes the system of example 35, wherein the first chord is monolithic and passes through the first proximal pledget and the first distal pledget.
  • Example 40 includes the system of example 35, wherein the first distal pledget is deformable.
  • Example 41 includes the system of example 35, wherein the first chord includes a first chord material, the first proximal pledget includes a first proximal pledget material, and the first distal pledget includes a first distal pledget material that is the same as the first chord material and the first proximal pledget material.
  • Example 42 includes the system of example 41, wherein the first distal pledget material includes at least one of polytetrafluoroethylene and expanded
  • Example 43 includes the system of example 35 comprising: a second needle; a flexible second chord coupled to a proximal end portion of the second needle, the first proximal pledget being coupled to a proximal end portion of the second chord; a second distal pledget coupled to the second chord between the first proximal pledget and the second needle.
  • Example 44 includes the system of example 43 comprising: a third needle; a flexible third chord coupled to an end portion of the third needle and to the first proximal pledget; wherein the third chord is between the first proximal pledget and the third needle.
  • Example 45 includes the system of example 35 comprising: a second needle; a flexible second chord coupled to an end portion of the second needle and to the first proximal pledget; wherein the second chord is between the first proximal pledget and the second needle.
  • Example 46 includes the system of example 35, wherein: the first needle has a first maximum outer diameter; the first distal pledget has a second maximum outer diameter; and the first chord has third maximum outer diameter that is less than (a) the first maximum outer diameter, and (b) the second maximum outer diameter.
  • Example 47 includes an artificial chordae tendineae system comprising: a first needle; a flexible first chord coupled to a proximal end portion of the first needle; a first proximal pledget coupled to a proximal end portion of the first chord; a first distal conduit coupled to the first chord between the first proximal pledget and the first needle; wherein: the first distal conduit includes first and second faces; one of the first and second faces includes a first aperture; a sidewall of the first conduit, located between the first and second faces, includes a sidewall aperture that does not directly connect to the first aperture; the sidewall aperture is configured to include a portion of the first chord when the first distal conduit is permanently implanted adjacent tissue but not when the first distal conduit is traversing the tissue before being permanently implanted adjacent the tissue.
  • Figures 11(A)- 11(D) and 12-14 illustrate embodiments with a proximal pledget (e.g., element 704 of Figure 11(A)) that does not necessarily include a conduit and a distal conduit (e.g., element 706 of Figure 11(A) or Figure 15).
  • a proximal pledget e.g., element 704 of Figure 11(A)
  • a distal conduit e.g., element 706 of Figure 11(A) or Figure 15.
  • Such an embodiment may be particularly useful for situations where the deployable pledget (e.g., element 706 of Figure 1 1(A)) will advance through tissue but the proximal pledget (e.g., element 704 of Figure 11(A)) does not advance through tissue.
  • Example 48 includes the system of example 47, wherein the first chord is monolithic and passes through the first distal conduit.
  • Example 49 includes the system of example 47, wherein the first distal conduit has a beveled edge to facilitate traversal of the first distal conduit through the tissue.
  • Example 50 includes the system of example 47, wherein: the first needle has a first maximum outer diameter; the first distal conduit has a second maximum outer diameter; and the first chord has third maximum outer diameter that is less than (a) the first maximum outer diameter, and (b) the second maximum outer diameter.
  • Example 51 includes the system of example 1, wherein: the first distal conduit includes first and second end portions; the first end portion includes a first face comprising a first aperture that includes the first chord; the second end portion is configured to directly contact the first chord when the system is in the first system orientation but to not directly contact the first chord when the system is in the second system orientation.
  • terms designating relative vertical position refer to a situation where a side of a substrate is the "top” surface of that substrate; the substrate may actually be in any orientation so that a "top” side of a substrate may be lower than the “bottom” side in a standard terrestrial frame of reference and still fall within the meaning of the term "top.”
  • the embodiments of a device or article described herein can be manufactured, used, or shipped in a number of positions and orientations. Persons skilled in the relevant art can appreciate that many modifications and variations are possible in light of the above teaching. Persons skilled in the art will recognize various equivalent combinations and substitutions for various components shown in the Figures. It is therefore intended that the scope of the invention be limited not by this detailed description, but rather by the claims appended hereto.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Cardiology (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Surgery (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Medical Informatics (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Molecular Biology (AREA)
  • Rheumatology (AREA)
  • Oral & Maxillofacial Surgery (AREA)
  • Transplantation (AREA)
  • Vascular Medicine (AREA)
  • Prostheses (AREA)
  • Surgical Instruments (AREA)

Abstract

Un mode de réalisation comprend un système de cordages tendineux artificiels comprenant : une première aiguille ; un premier cordage souple accouplé à une partie d'extrémité proximale de la première aiguille ; une première compresse proximale accouplée à une partie d'extrémité proximale du premier cordage ; un premier conduit distal accouplé au premier cordage entre la première compresse proximale et la première aiguille ; le premier conduit distal comprenant une première et une seconde face ; la première et/ou la seconde face comprenant une première ouverture ; une paroi latérale du premier conduit, située entre les première et seconde faces, comprenant une ouverture de paroi latérale qui n'est pas directement raccordée à la première ouverture ; l'ouverture de paroi latérale étant conçue pour comprendre une partie du premier cordage lorsque le premier conduit distal est implanté de manière permanente au voisinage du tissu, mais pas lorsque le premier conduit distal traverse le tissu avant d'être implanté de manière permanente au voisinage du tissu.
PCT/US2017/035463 2016-06-01 2017-06-01 Système de cordages tendineux rapportés WO2017210434A1 (fr)

Priority Applications (2)

Application Number Priority Date Filing Date Title
US16/305,945 US11103350B2 (en) 2016-06-01 2017-06-01 Pull-through chordae tendineae system
US17/411,174 US20220039952A1 (en) 2016-06-01 2021-08-25 Pull-through chordae tendineae system

Applications Claiming Priority (4)

Application Number Priority Date Filing Date Title
US201662343957P 2016-06-01 2016-06-01
US62/343,957 2016-06-01
US201762447681P 2017-01-18 2017-01-18
US62/447,681 2017-01-18

Related Child Applications (2)

Application Number Title Priority Date Filing Date
US16/305,945 A-371-Of-International US11103350B2 (en) 2016-06-01 2017-06-01 Pull-through chordae tendineae system
US17/411,174 Continuation US20220039952A1 (en) 2016-06-01 2021-08-25 Pull-through chordae tendineae system

Publications (1)

Publication Number Publication Date
WO2017210434A1 true WO2017210434A1 (fr) 2017-12-07

Family

ID=60477887

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/US2017/035463 WO2017210434A1 (fr) 2016-06-01 2017-06-01 Système de cordages tendineux rapportés

Country Status (2)

Country Link
US (2) US11103350B2 (fr)
WO (1) WO2017210434A1 (fr)

Families Citing this family (64)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US8608797B2 (en) 2005-03-17 2013-12-17 Valtech Cardio Ltd. Mitral valve treatment techniques
US9974653B2 (en) 2006-12-05 2018-05-22 Valtech Cardio, Ltd. Implantation of repair devices in the heart
US11259924B2 (en) 2006-12-05 2022-03-01 Valtech Cardio Ltd. Implantation of repair devices in the heart
US11660190B2 (en) 2007-03-13 2023-05-30 Edwards Lifesciences Corporation Tissue anchors, systems and methods, and devices
US8382829B1 (en) 2008-03-10 2013-02-26 Mitralign, Inc. Method to reduce mitral regurgitation by cinching the commissure of the mitral valve
US8241351B2 (en) 2008-12-22 2012-08-14 Valtech Cardio, Ltd. Adjustable partial annuloplasty ring and mechanism therefor
US8715342B2 (en) 2009-05-07 2014-05-06 Valtech Cardio, Ltd. Annuloplasty ring with intra-ring anchoring
EP2379008B1 (fr) 2008-12-22 2021-02-17 Valtech Cardio, Ltd. Dispositif d'annuloplastie réglable
US8911494B2 (en) 2009-05-04 2014-12-16 Valtech Cardio, Ltd. Deployment techniques for annuloplasty ring
US10517719B2 (en) 2008-12-22 2019-12-31 Valtech Cardio, Ltd. Implantation of repair devices in the heart
US8353956B2 (en) 2009-02-17 2013-01-15 Valtech Cardio, Ltd. Actively-engageable movement-restriction mechanism for use with an annuloplasty structure
US9968452B2 (en) 2009-05-04 2018-05-15 Valtech Cardio, Ltd. Annuloplasty ring delivery cathethers
US9180007B2 (en) 2009-10-29 2015-11-10 Valtech Cardio, Ltd. Apparatus and method for guide-wire based advancement of an adjustable implant
US10098737B2 (en) 2009-10-29 2018-10-16 Valtech Cardio, Ltd. Tissue anchor for annuloplasty device
EP2506777B1 (fr) 2009-12-02 2020-11-25 Valtech Cardio, Ltd. Combinaison d'un ensemble de bobine couplé à un ancrage hélicoïdal et d'un outil distributeur pour son implantation
US10792152B2 (en) 2011-06-23 2020-10-06 Valtech Cardio, Ltd. Closed band for percutaneous annuloplasty
US8858623B2 (en) 2011-11-04 2014-10-14 Valtech Cardio, Ltd. Implant having multiple rotational assemblies
US9724192B2 (en) 2011-11-08 2017-08-08 Valtech Cardio, Ltd. Controlled steering functionality for implant-delivery tool
EP2886084B1 (fr) 2011-12-12 2018-02-14 David Alon Dispositif de réparation de valvule cardiaque
WO2014052818A1 (fr) 2012-09-29 2014-04-03 Mitralign, Inc. Système de distribution de verrous de plicature et procédé d'utilisation de celui-ci
EP2911593B1 (fr) 2012-10-23 2020-03-25 Valtech Cardio, Ltd. Techniques d'ancrage de tissu percutané
WO2014064694A2 (fr) 2012-10-23 2014-05-01 Valtech Cardio, Ltd. Fonctionnalité d'orientation commandée pour outil de pose d'implant
US9730793B2 (en) 2012-12-06 2017-08-15 Valtech Cardio, Ltd. Techniques for guide-wire based advancement of a tool
US9724084B2 (en) 2013-02-26 2017-08-08 Mitralign, Inc. Devices and methods for percutaneous tricuspid valve repair
US10449333B2 (en) 2013-03-14 2019-10-22 Valtech Cardio, Ltd. Guidewire feeder
EP2968847B1 (fr) 2013-03-15 2023-03-08 Edwards Lifesciences Corporation Systèmes de cathéters de translation
US10070857B2 (en) 2013-08-31 2018-09-11 Mitralign, Inc. Devices and methods for locating and implanting tissue anchors at mitral valve commissure
WO2015059699A2 (fr) 2013-10-23 2015-04-30 Valtech Cardio, Ltd. Chargeur d'éléments d'ancrage
US9610162B2 (en) 2013-12-26 2017-04-04 Valtech Cardio, Ltd. Implantation of flexible implant
GB2536538B (en) 2014-09-17 2018-07-18 Cardiomech As Anchor for implantation in body tissue
EP3206629B1 (fr) 2014-10-14 2021-07-14 Valtech Cardio, Ltd. Dispositif de retenue de feuillets de valve cardiaque
US20160256269A1 (en) 2015-03-05 2016-09-08 Mitralign, Inc. Devices for treating paravalvular leakage and methods use thereof
CA2982063A1 (fr) 2015-04-30 2016-11-03 Valtech Cardio, Ltd. Technologies d'annuloplastie
US10828160B2 (en) 2015-12-30 2020-11-10 Edwards Lifesciences Corporation System and method for reducing tricuspid regurgitation
US10702274B2 (en) 2016-05-26 2020-07-07 Edwards Lifesciences Corporation Method and system for closing left atrial appendage
GB201611910D0 (en) 2016-07-08 2016-08-24 Valtech Cardio Ltd Adjustable annuloplasty device with alternating peaks and troughs
US11045627B2 (en) 2017-04-18 2021-06-29 Edwards Lifesciences Corporation Catheter system with linear actuation control mechanism
US10835221B2 (en) 2017-11-02 2020-11-17 Valtech Cardio, Ltd. Implant-cinching devices and systems
US11135062B2 (en) 2017-11-20 2021-10-05 Valtech Cardio Ltd. Cinching of dilated heart muscle
CN116531147A (zh) 2018-01-24 2023-08-04 爱德华兹生命科学创新(以色列)有限公司 瓣环成形术结构的收缩
WO2019145941A1 (fr) 2018-01-26 2019-08-01 Valtech Cardio, Ltd. Techniques pour faciliter la fixation de valve cardiaque et le remplacement de cordon
WO2019195860A2 (fr) 2018-04-04 2019-10-10 Vdyne, Llc Dispositifs et procédés d'ancrage d'une valvule cardiaque transcathéter
CR20210020A (es) 2018-07-12 2021-07-21 Valtech Cardio Ltd Sistema de anuloplastía y herramientas de bloqueo para ello
US11071627B2 (en) 2018-10-18 2021-07-27 Vdyne, Inc. Orthogonally delivered transcatheter heart valve frame for valve in valve prosthesis
US11344413B2 (en) 2018-09-20 2022-05-31 Vdyne, Inc. Transcatheter deliverable prosthetic heart valves and methods of delivery
US10595994B1 (en) 2018-09-20 2020-03-24 Vdyne, Llc Side-delivered transcatheter heart valve replacement
US11278437B2 (en) 2018-12-08 2022-03-22 Vdyne, Inc. Compression capable annular frames for side delivery of transcatheter heart valve replacement
US10321995B1 (en) 2018-09-20 2019-06-18 Vdyne, Llc Orthogonally delivered transcatheter heart valve replacement
US11109969B2 (en) 2018-10-22 2021-09-07 Vdyne, Inc. Guidewire delivery of transcatheter heart valve
US11253359B2 (en) 2018-12-20 2022-02-22 Vdyne, Inc. Proximal tab for side-delivered transcatheter heart valves and methods of delivery
US10653522B1 (en) 2018-12-20 2020-05-19 Vdyne, Inc. Proximal tab for side-delivered transcatheter heart valve prosthesis
US11273032B2 (en) 2019-01-26 2022-03-15 Vdyne, Inc. Collapsible inner flow control component for side-deliverable transcatheter heart valve prosthesis
US11185409B2 (en) 2019-01-26 2021-11-30 Vdyne, Inc. Collapsible inner flow control component for side-delivered transcatheter heart valve prosthesis
CA3132162A1 (fr) 2019-03-05 2020-09-10 Vdyne, Inc. Dispositifs de regulation de regurgitation tricuspide pour prothese de valvule cardiaque transcatheter orthogonale
US10758346B1 (en) 2019-03-14 2020-09-01 Vdyne, Inc. A2 clip for side-delivered transcatheter mitral valve prosthesis
US10631983B1 (en) 2019-03-14 2020-04-28 Vdyne, Inc. Distal subannular anchoring tab for side-delivered transcatheter valve prosthesis
US11076956B2 (en) 2019-03-14 2021-08-03 Vdyne, Inc. Proximal, distal, and anterior anchoring tabs for side-delivered transcatheter mitral valve prosthesis
US11173027B2 (en) 2019-03-14 2021-11-16 Vdyne, Inc. Side-deliverable transcatheter prosthetic valves and methods for delivering and anchoring the same
CN114072106A (zh) 2019-05-04 2022-02-18 维迪内股份有限公司 用于在自体瓣环中部署侧面递送的假体心脏瓣膜的束紧装置和方法
JP2022544707A (ja) 2019-08-20 2022-10-20 ブイダイン，インコーポレイテッド 側方送達可能な経カテーテル人工弁の送達及び回収のデバイス及び方法
WO2021040996A1 (fr) 2019-08-26 2021-03-04 Vdyne, Inc. Valvules prothétiques transcathéter à pose latérale et procédés pour leurs pose et ancrage
AU2020375903A1 (en) 2019-10-29 2021-12-23 Edwards Lifesciences Innovation (Israel) Ltd. Annuloplasty and tissue anchor technologies
US11234813B2 (en) 2020-01-17 2022-02-01 Vdyne, Inc. Ventricular stability elements for side-deliverable prosthetic heart valves and methods of delivery
WO2023062522A1 (fr) * 2021-10-12 2023-04-20 Spectrum Technologies, Llc Dispositif, système et procédé de réparation de valvule cardiaque

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20090177274A1 (en) * 2006-06-07 2009-07-09 Marcio Scorsin Device for replacing the chordae tendineae of an atrioventricular valve
US20100179574A1 (en) * 2009-01-14 2010-07-15 James Longoria Synthetic chord
US20120209377A1 (en) * 2000-09-20 2012-08-16 Mvrx, Inc. Devices, systems, and methods for reshaping a heart valve annulus, including the use of magnetic tools
US20140142689A1 (en) * 2012-11-21 2014-05-22 Didier De Canniere Device and method of treating heart valve malfunction
US20150216662A1 (en) * 2012-08-17 2015-08-06 On-X Life Technologies, Inc. Biological Chord Repair System and Methods

Family Cites Families (70)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US6010531A (en) 1993-02-22 2000-01-04 Heartport, Inc. Less-invasive devices and methods for cardiac valve surgery
US5307924A (en) 1993-03-26 1994-05-03 Abbott Laboratories Packaging for T-shaped tension devices
US5391182A (en) 1993-08-03 1995-02-21 Origin Medsystems, Inc. Apparatus and method for closing puncture wounds
US5431666A (en) 1994-02-24 1995-07-11 Lasersurge, Inc. Surgical suture instrument
US6050936A (en) 1997-01-02 2000-04-18 Myocor, Inc. Heart wall tension reduction apparatus
AU9225598A (en) 1997-09-04 1999-03-22 Endocore, Inc. Artificial chordae replacement
CA2369641C (fr) 1999-04-09 2009-02-10 Evalve, Inc. Procede et dispositif de reparation de valvule cardiaque
US6626930B1 (en) 1999-10-21 2003-09-30 Edwards Lifesciences Corporation Minimally invasive mitral valve repair method and apparatus
US7153312B1 (en) 1999-12-02 2006-12-26 Smith & Nephew Inc. Closure device and method for tissue repair
US6797002B2 (en) 2000-02-02 2004-09-28 Paul A. Spence Heart valve repair apparatus and methods
US6869444B2 (en) 2000-05-22 2005-03-22 Shlomo Gabbay Low invasive implantable cardiac prosthesis and method for helping improve operation of a heart valve
US20020188170A1 (en) 2001-04-27 2002-12-12 Santamore William P. Prevention of myocardial infarction induced ventricular expansion and remodeling
US7819897B2 (en) 2001-11-20 2010-10-26 Sofradim Production Fastener for fixing a prosthesis, and device for delivering this fastener
US20070112338A1 (en) 2005-11-01 2007-05-17 Microfabrica Inc. Microdevices for tissue approximation and retention, methods for using, and methods for making
US6978176B2 (en) 2001-12-08 2005-12-20 Lattouf Omar M Treatment for patient with congestive heart failure
US7241257B1 (en) 2002-06-28 2007-07-10 Abbott Cardiovascular Systems, Inc. Devices and methods to perform minimally invasive surgeries
US8292884B2 (en) 2002-08-01 2012-10-23 Levine Robert A Cardiac devices and methods for minimally invasive repair of ischemic mitral regurgitation
US6966916B2 (en) 2002-09-26 2005-11-22 Kumar Sarbjeet S Device and method for surgical repair of abdominal wall hernias
US7087064B1 (en) 2002-10-15 2006-08-08 Advanced Cardiovascular Systems, Inc. Apparatuses and methods for heart valve repair
US6997950B2 (en) 2003-01-16 2006-02-14 Chawla Surendra K Valve repair device
US6945996B2 (en) 2003-04-18 2005-09-20 Sedransk Kyra L Replacement mitral valve
JP4145200B2 (ja) 2003-06-06 2008-09-03 オリンパス株式会社 縫合器
US20050038509A1 (en) 2003-08-14 2005-02-17 Ashe Kassem Ali Valve prosthesis including a prosthetic leaflet
EP1689329A2 (fr) 2003-11-12 2006-08-16 Medtronic Vascular, Inc. Systeme de reduction de l'annulus des valvules cardiaques
US7736379B2 (en) 2004-06-09 2010-06-15 Usgi Medical, Inc. Compressible tissue anchor assemblies
US8206417B2 (en) 2004-06-09 2012-06-26 Usgi Medical Inc. Apparatus and methods for optimizing anchoring force
WO2006041877A2 (fr) 2004-10-05 2006-04-20 Ample Medical, Inc. Systemes et procedes de reparation d'un anneau de valvule auriculo-ventriculaire faisant appel a des ancrages retro-chordaux
US20060229708A1 (en) 2005-02-07 2006-10-12 Powell Ferolyn T Methods, systems and devices for cardiac valve repair
US20110060407A1 (en) 2005-02-07 2011-03-10 Ted Ketai Methods, systems and devices for cardiac valve repair
US7896891B2 (en) 2005-05-20 2011-03-01 Neotract, Inc. Apparatus and method for manipulating or retracting tissue and anatomical structure
US8333776B2 (en) 2005-05-20 2012-12-18 Neotract, Inc. Anchor delivery system
US7645286B2 (en) 2005-05-20 2010-01-12 Neotract, Inc. Devices, systems and methods for retracting, lifting, compressing, supporting or repositioning tissues or anatomical structures
US9549739B2 (en) 2005-05-20 2017-01-24 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US8157815B2 (en) 2005-05-20 2012-04-17 Neotract, Inc. Integrated handle assembly for anchor delivery system
US8425535B2 (en) 2005-05-20 2013-04-23 Neotract, Inc. Multi-actuating trigger anchor delivery system
US7758594B2 (en) 2005-05-20 2010-07-20 Neotract, Inc. Devices, systems and methods for treating benign prostatic hyperplasia and other conditions
US20060287716A1 (en) 2005-06-08 2006-12-21 The Cleveland Clinic Foundation Artificial chordae
US20070049952A1 (en) 2005-08-30 2007-03-01 Weiss Steven J Apparatus and method for mitral valve repair without cardiopulmonary bypass, including transmural techniques
US7850712B2 (en) 2005-11-15 2010-12-14 Ethicon Endo-Surgery, Inc. Self-shielding suture anchor
US20070118151A1 (en) 2005-11-21 2007-05-24 The Brigham And Women's Hospital, Inc. Percutaneous cardiac valve repair with adjustable artificial chordae
US7632308B2 (en) 2005-11-23 2009-12-15 Didier Loulmet Methods, devices, and kits for treating mitral valve prolapse
RS20060147A (en) 2006-03-02 2008-04-04 Uroš Babić Implant, apparatus and implantation method for catheter based mitral valve repair
US7635386B1 (en) 2006-03-07 2009-12-22 University Of Maryland, Baltimore Methods and devices for performing cardiac valve repair
US7431692B2 (en) 2006-03-09 2008-10-07 Edwards Lifesciences Corporation Apparatus, system, and method for applying and adjusting a tensioning element to a hollow body organ
US20080228272A1 (en) 2006-12-04 2008-09-18 Micardia Corporation Dynamically adjustable suture and chordae tendinae
EP3345572A1 (fr) 2007-02-14 2018-07-11 Edwards Lifesciences Corporation Dispositif et procédé de réparation cardiaque
US8308766B2 (en) 2007-02-27 2012-11-13 Olympus Medical Systems Corp. Endoscopic treatment instrument
US8303622B2 (en) 2007-03-14 2012-11-06 St. Jude Medical, Inc. Heart valve chordae replacement methods and apparatus
US20090088837A1 (en) 2007-09-28 2009-04-02 The Cleveland Clinic Foundation Prosthetic chordae assembly and method of use
US8758393B2 (en) 2007-10-18 2014-06-24 Neochord, Inc. Minimally invasive repair of a valve leaflet in a beating heart
US20090182192A1 (en) 2008-01-14 2009-07-16 Olympus Medical Systems Corp. Treating tool for endoscope
DK3967274T3 (da) 2008-04-23 2022-10-03 Medtronic Inc Hjerteklapanordninger med stent
US20100023118A1 (en) 2008-07-24 2010-01-28 Edwards Lifesciences Corporation Method and apparatus for repairing or replacing chordae tendinae
JP5571079B2 (ja) 2008-07-30 2014-08-13 ネオトラクト インコーポレイテッド 交換式カートリッジを持つアンカー送出システム
US8778016B2 (en) 2008-08-14 2014-07-15 Edwards Lifesciences Corporation Method and apparatus for repairing or replacing chordae tendinae
US8808368B2 (en) 2008-12-22 2014-08-19 Valtech Cardio, Ltd. Implantation of repair chords in the heart
US8911494B2 (en) 2009-05-04 2014-12-16 Valtech Cardio, Ltd. Deployment techniques for annuloplasty ring
US20110011917A1 (en) 2008-12-31 2011-01-20 Hansen Medical, Inc. Methods, devices, and kits for treating valve prolapse
US8439969B2 (en) 2009-03-31 2013-05-14 The Cleveland Clinic Foundation Pre-sized prosthetic chordae implantation system
EP3042615A1 (fr) 2009-09-15 2016-07-13 Evalve, Inc. Procédés, systèmes et dispositifs de réparation de valvule cardiaque
AU2015200387B2 (en) 2010-04-13 2016-11-17 Atricure, Inc. Methods and devices for accessing and delivering devices to a heart
WO2012040865A1 (fr) 2010-10-01 2012-04-05 Alberto Weber Appareil médical et procédé de réparation d'une valvule cardiaque
CN103491901B (zh) 2011-04-04 2016-04-20 特拉维夫医学中心医学研究,基础设施及健康服务基金 心脏瓣膜修补的设备和方法
EP3395298A1 (fr) 2011-06-27 2018-10-31 University of Maryland, Baltimore Dispositif de réparation de valvule mitrale transapicale
US9364326B2 (en) 2011-06-29 2016-06-14 Mitralix Ltd. Heart valve repair devices and methods
EP3705090B1 (fr) 2011-08-11 2023-12-06 Tendyne Holdings, Inc. Améliorations apportées à des valves prothétiques et inventions associées
WO2014093861A1 (fr) 2012-12-14 2014-06-19 Mayo Foundation For Medical Education And Research Dispositifs de réparation de valve mitrale
EP3003223A4 (fr) 2013-06-05 2017-01-25 LC Therapeutics, Inc. Corde synthétique pour des applications de réparation de valvule cardiaque
CA2920384A1 (fr) * 2013-08-06 2015-02-12 Lc Therapeutics, Inc. Cordon synthetique pour applications de reparation de valvules cardiaques
US9480565B2 (en) 2015-02-02 2016-11-01 On-X Life Technologies, Inc. Rapid deployment artificial chordae tendinae system

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20120209377A1 (en) * 2000-09-20 2012-08-16 Mvrx, Inc. Devices, systems, and methods for reshaping a heart valve annulus, including the use of magnetic tools
US20090177274A1 (en) * 2006-06-07 2009-07-09 Marcio Scorsin Device for replacing the chordae tendineae of an atrioventricular valve
US20100179574A1 (en) * 2009-01-14 2010-07-15 James Longoria Synthetic chord
US20150216662A1 (en) * 2012-08-17 2015-08-06 On-X Life Technologies, Inc. Biological Chord Repair System and Methods
US20140142689A1 (en) * 2012-11-21 2014-05-22 Didier De Canniere Device and method of treating heart valve malfunction

Also Published As

Publication number Publication date
US20220039952A1 (en) 2022-02-10
US11103350B2 (en) 2021-08-31
US20190117400A1 (en) 2019-04-25

Similar Documents

Publication Publication Date Title
US20220039952A1 (en) Pull-through chordae tendineae system
US10213303B2 (en) Rapid deployment artificial chordae Tendinae system
JP7319021B2 (ja) 心臓弁の修復用の医療インプラントおよび方法
US20210236286A1 (en) Biological Chord Repair System and Methods
CN110325125B (zh) 用于新生腱索的经血管植入的方法和设备
EP2427145B1 (fr) Système de déploiement d'anneau d'annuloplastie et outil de rotation sur fil
US9592122B2 (en) Annuloplasty ring with intra-ring anchoring
US20150250590A1 (en) Transapical mitral chordae replacement
JP2010131404A (ja) 組織を固定するための装置および方法
JP2010511469A (ja) セグメント化リング配置

Legal Events

Date Code Title Description
121 Ep: the epo has been informed by wipo that ep was designated in this application

Ref document number: 17807483

Country of ref document: EP

Kind code of ref document: A1

NENP Non-entry into the national phase

Ref country code: DE

122 Ep: pct application non-entry in european phase

Ref document number: 17807483

Country of ref document: EP

Kind code of ref document: A1